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Guida L, Grenier-Chartrand F, Benichi S, James S, Paternoster G, Bourgeois M, Dangouloff-Ros V, Messina A, Boddaert N, Puget S, Beccaria K, Blauwblomme T. Predicting endoscopic third ventriculostomy success in pediatric shunt dysfunction: a monocentric retrospective case series of 70 consecutive children, systematic review, and meta-analysis. J Neurosurg Pediatr 2023; 32:638-648. [PMID: 37877943 DOI: 10.3171/2023.9.peds23208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/05/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE The outcome of endoscopic third ventriculostomy (ETV) in children who had previously received shunts and who were experiencing shunt dysfunction is still discussed in terms of efficacy (success rate from 40% to 80%) and safety (0%-32.5% of complications). Reported predictive factors of secondary ETV failure are age, early onset of hydrocephalus, and prematurity. The best surgical strategy in the different subgroups of patients with shunt dysfunction is still debated. Therefore, the authors aimed to identify subgroups of patients in whom shunt treatment was associated with favorable outcome of ETV, to define the role of ETV in patients with global rostral midbrain dysfunction syndrome. METHODS This study was a monocentric retrospective case series and a meta-analysis of children who had previously received shunts and who underwent secondary ETV for shunt dysfunction between 2012 and 2022. Clinical and MRI features were examined, along with surgical outcome, etiology of hydrocephalus, and preoperative ETV Success Score. Univariate and multivariate analyses were performed to find predictors of outcome of secondary ETV. Youden's J index was calculated on age distribution to find an optimal age cutoff. Systematic review of the literature and a meta-analysis were performed according to the PRISMA statement. RESULTS Seventy consecutive patients were included. The overall success rate of secondary ETV was 63%. Primary obstructive hydrocephalus, age ≥ 36 months, and the presence of aqueductal obstruction were predictors of ETV success. Multivariate analysis found that age < 36 months, primary inflammatory hydrocephalus, and presence of fourth ventricular obstruction were associated with ETV failure. All patients with global rostral midbrain dysfunction syndrome experienced clinical and radiological improvement after ETV. The meta-analysis showed that postinflammatory etiology and age < 36 months were predictors of ETV failure. CONCLUSIONS ETV is safe and effective for children with obstructive hydrocephalus experiencing shunt dysfunction, notably in cases of primary obstructive hydrocephalus with aqueductal stenosis, and among children whose age was ≥ 36 months who had postinflammatory hydrocephalus.
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Affiliation(s)
- Lelio Guida
- Departments of1Pediatric Neurosurgery and
- 2University of Paris City, Paris, France
| | - Flavie Grenier-Chartrand
- Departments of1Pediatric Neurosurgery and
- 3Department of Neurosurgery, Free University of Brussels (ULB), Brussels University Hospital, CUB Erasmus Hospital, Brussels, Belgium; and
| | - Sandro Benichi
- Departments of1Pediatric Neurosurgery and
- 2University of Paris City, Paris, France
| | | | | | | | - Volodia Dangouloff-Ros
- 4Pediatric Radiology, APHP, Hôpital Necker Enfants Malades, Paris, France
- 5Imagine Institute, University of Paris City, Paris, France
| | - Antonio Messina
- 4Pediatric Radiology, APHP, Hôpital Necker Enfants Malades, Paris, France
| | - Nathalie Boddaert
- 4Pediatric Radiology, APHP, Hôpital Necker Enfants Malades, Paris, France
- 5Imagine Institute, University of Paris City, Paris, France
| | - Stéphanie Puget
- Departments of1Pediatric Neurosurgery and
- 2University of Paris City, Paris, France
| | - Kevin Beccaria
- Departments of1Pediatric Neurosurgery and
- 2University of Paris City, Paris, France
| | - Thomas Blauwblomme
- Departments of1Pediatric Neurosurgery and
- 2University of Paris City, Paris, France
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Grenier-Chartrand F, Taverne M, James S, Guida L, Paternoster G, Loiselet K, Beccaria K, Dangouloff-Ros V, Levy R, de Saint Denis T, Blauwblomme T, Khonsari RH, Boddaert N, Benichi S. Mobility Assessment Using Multi-Positional MRI in Children with Cranio-Vertebral Junction Anomalies. J Clin Med 2023; 12:6714. [PMID: 37959181 PMCID: PMC10650482 DOI: 10.3390/jcm12216714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE This study aimed to assess the relevance of using multi-positional MRI (mMRI) to identify cranio-vertebral junction (CVJ) instability in pediatric patients with CVJ anomalies while determining objective mMRI criteria to detect this condition. MATERIAL AND METHODS Data from children with CVJ anomalies who underwent a mMRI between 2017 and 2021 were retrospectively reviewed. Mobility assessment using mMRI involved: (1) morphometric analysis using hierarchical clustering on principal component analysis (HCPCA) to identify clusters of patients by considering their mobility similarities, assessed through delta (Δ) values of occipito-cervical parameters measured on mMRI; and (2) morphological analysis based on dynamic geometric CVJ models and analysis of displacement vectors between flexion and extension. Receiver operating characteristics (ROC) curves were generated for occipito-cervical parameters to establish instability cut-off values. (3) Additionally, an anatomical qualitative analysis of the CVJ was performed to identify morphological criteria of instability. RESULTS Forty-seven patients with CVJ anomalies were included (26 females, 21 males; mean age: 10.2 years [3-18]). HCPCA identified 2 clusters: cluster №1 (stable patients, n = 39) and cluster №2 (unstable patients, n = 8). ΔpB-C2 (pB-C2 line delta) at ≥2.5 mm (AUC 0.98) and ΔBAI (Basion-axis Interval delta) ≥ 3 mm (AUC 0.97) predicted instability with 88% sensibility and 95% specificity and 88% sensitivity and 85% specificity, respectively. Geometric CVJ shape analysis differentiated patients along a continuum, from a low to a high CVJ motion that was characterized by a subluxation of C1 in the anterior direction. Qualitative analysis found correlations between instability and C2 anomalies, including fusions with C3 (body p = 0.032; posterior arch p = 0.045; inferior articular facets p = 0.012; lateral mass p = 0.029). CONCLUSIONS We identified a cluster of pediatric patients with CVJ instability among a cohort of CVJ anomalies that were characterized by morphometric parameters with corresponding cut-off values that could serve as objective mMRI criteria. These findings warrant further validation through prospective case-control studies.
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Affiliation(s)
- Flavie Grenier-Chartrand
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
- Department of Neurosurgery, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles, CUB Hôpital Erasme, 1070 Bruxelles, Belgium
| | - Maxime Taverne
- Craniofacial Growth and Form, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France;
| | - Syril James
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
- Reference Center for Rare Diseases C-MAVEM (Chiari, Spinal Cord and Vertebral Diseases), Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France
| | - Lelio Guida
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
| | - Giovanna Paternoster
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
| | - Klervie Loiselet
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
- Department of Pediatric Imaging, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France;
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
| | - Volodia Dangouloff-Ros
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
- Department of Pediatric Imaging, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France;
| | - Raphaël Levy
- Department of Pediatric Imaging, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France;
| | - Timothée de Saint Denis
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
- Reference Center for Rare Diseases C-MAVEM (Chiari, Spinal Cord and Vertebral Diseases), Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
| | - Roman Hossein Khonsari
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
- Craniofacial Growth and Form, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France;
- Department of Maxillofacial Surgery and Plastic Surgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France
| | - Nathalie Boddaert
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
- Department of Pediatric Imaging, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France;
| | - Sandro Benichi
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
- Reference Center for Rare Diseases C-MAVEM (Chiari, Spinal Cord and Vertebral Diseases), Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France
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Grenier-Chartrand F, Barrit S, Racu ML, Luce S, Spitaels J, Sadeghi-Meibodi N, Lebrun L, Salmon I, Lefranc F, De Witte O. Dabrafenib monotherapy for a recurrent BRAFV600E-mutated TTF-1-positive posterior pituitary tumor. Acta Neurochir (Wien) 2022; 164:737-742. [PMID: 35029761 DOI: 10.1007/s00701-022-05109-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
Posterior pituitary tumors (PPT) expressing thyroid transcription factor-1 (TTF-1) are extremely rare low-grade neoplasms. The recent discovery of BRAF mutations in these tumors offers a potential alternative treatment using targeted therapies. We present the case of a 57-year-old female with recurrent BRAFV600E-mutated TTF-1-positive PPT treated with a BRAF inhibitor monotherapy (dabrafenib) leading to tumor regression. After 18 months of uninterrupted treatment, ongoing radiological tumor regression was observed and the patient remained asymptomatic without any significant adverse event. BRAF inhibitor is potentially a valuable treatment option for recurrent TTF-1-positive PPT with BRAF mutation.
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Affiliation(s)
- Flavie Grenier-Chartrand
- Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Anderlecht, Belgium.
| | - Sami Barrit
- Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Anderlecht, Belgium
| | - Marie Lucie Racu
- Department of Pathology, Erasme Hospital, ULB, Anderlecht, Belgium
| | - Sylvie Luce
- Department of Oncology, Erasme Hospital, ULB, Anderlecht, Belgium
| | - Julien Spitaels
- Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Anderlecht, Belgium
| | | | - Laetitia Lebrun
- Department of Pathology, Erasme Hospital, ULB, Anderlecht, Belgium
| | - Isabelle Salmon
- Department of Pathology, Erasme Hospital, ULB, Anderlecht, Belgium
| | - Florence Lefranc
- Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Anderlecht, Belgium
| | - Olivier De Witte
- Department of Neurosurgery, Erasme Hospital, ULB, Route de Lennik, 808, 1070, Anderlecht, Belgium
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